[Left-ventricular thrombosis in recent myocardial infarction. An echocardiographic study]

To evaluate the incidence of left-ventricular thrombosis (LVT) in recent myocardial infarction (MI), M-mode and two-dimensional echocardiography (2DE) were performed in 200 patients enrolled in a rehabilitation program, three to 12 weeks after the acute episode (average 6 weeks). LVT was detected in 36 of 125 patients with anterior MI and in 4 of 75 patients with inferior MI. The presence of LVT correlated well with the electrocardiographic extension of myocardial necrosis; 90% of LVT was detected in patients with extensive MI. The same behaviour seems to be found in MI without evidence of ECG Q waves: 3 of 8 patients with extensive non-transmural MI had LVT. All thrombi were located at the apex. For this reason the apical acoustic window is the most useful in diagnosing LVT. All patients with LVT showed severe apical wall-motion abnormalities (akinesis, dyskinesis, aneurysm); the motion of the lower-posterolateral, septal and anterolateral segments was also frequently abnormal. None of the 40 patients with LVT had clinical evidence of systemic embolization during the in-hospital period. M-mode recordings wer of no help. Left ventricular diastolic dimensions and fractional shortening could not identify subgroups of patients at risk for LVT. In conclusion, patients with a recent large MI and severe apical wall-motion abnormalities are at high risk for LVT; nevertheless, the risk of systemic embolization seems to be virtually absent. 2DE is a useful screening technique for detecting LV in patients with recent MI before cineventriculography and cardiac surgery.